Early results after transatrial/transpulmonary repair of tetralogy of Fallot

Objectives: Right ventricular (RV) dysfunction is a significant cause of morbidity and mortality after surgical correction of tetralogy of Fallot (TOF). Transatrial/transpulmonary repair avoids a ventriculotomy (in contrast to the transventricular approach) emphasizing maximal preservation of RV str...

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Published in:	European journal of cardio-thoracic surgery Vol. 22; no. 4; pp. 582 - 586
Main Authors:	Giannopoulos, N.M., Chatzis, A.K., Karros, P., Zavaropoulos, P., Papagiannis, J., Rammos, S., Kirvassilis, G.V., Sarris, G.E.
Format:	Journal Article
Language:	English
Published:	Germany Elsevier Science B.V 01-10-2002
Subjects:	Cardiopulmonary Bypass Child, Preschool Congenital heart surgery Echocardiography Female Follow-Up Studies Heart Arrest, Induced Heart Atria - surgery Humans Infant Length of Stay Male Pulmonary Artery - surgery Reoperation Tetralogy of Fallot Tetralogy of Fallot - diagnostic imaging Tetralogy of Fallot - surgery Transatrial/transpulmonary repair of tetralogy of Fallot Treatment Outcome Tetralogy of Fallot Congenital heart surgery Transatrial/transpulmonary repair of tetralogy of Fallot
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Summary:	Objectives: Right ventricular (RV) dysfunction is a significant cause of morbidity and mortality after surgical correction of tetralogy of Fallot (TOF). Transatrial/transpulmonary repair avoids a ventriculotomy (in contrast to the transventricular approach) emphasizing maximal preservation of RV structure and function. We have adopted this technique as less traumatic for the right ventricle. This study evaluates the early surgical results of our approach. Methods: Between September 1997 and July 2001, 110 consecutive patients with TOF were referred to our unit for surgical therapy. Of these, 14 were unsuitable for repair and underwent aortopulmonary shunting±pulmonary artery patching. In the remaining 96 patients (median age 1.4 years), complete transatrial/transpulmonary repair was performed. Previously placed shunts (ten patients) were taken down and any secondary stenoses or branch pulmonary artery distortion repaired. In all cases, subpulmonary resection and ventricular septal defect (VSD) closure were accomplished transatrially. Whenever pulmonary valvotomy and valve ring widening were necessary, it was achieved through a pulmonary arteriotomy. In 84 patients the main pulmonary artery was augmented with an autologous pericardial patch, and in 23 the patch was extended to pulmonary artery branch(es). A limited (<1 cm ) or extended (>1 cm, but≤length of RV infundibulum) transannular incision was necessary in 59 and 18 patients, respectively, in order to achieve an adequate residual RV outflow tract diameter. A monocusp autologous pericardial valve was placed in 13 patients. Results: There was no death in this series. No patient required permanent pacemaker. In one case, early reoperation for residual RV outflow tract obstruction was needed. Median ICU and hospital stay were 3.5 and 10 days, respectively. At median follow up of 26 (mean 25±12) months, all patients are asymptomatic, with no significant residual lesion. Conclusions: Transatrial/transpulmonary repair of TOF is associated with remarkably low morbidity and mortality in our early experience.
Bibliography:	istex:714E7E809933C7209763BA63C02FE61D64E66EC3 ark:/67375/HXZ-S8BFCT0T-H ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1010-7940 1873-734X
DOI:	10.1016/S1010-7940(02)00403-7